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Modernize HIV testing policy

Tip O’Neill was right when he said all politics are local. The same might be said about epidemics.

Massachusetts has been successful in reducing its numbers of new HIV diagnoses. In just nine years, new HIV diagnoses fell from 1,369 in 1999 to 617 in 2007. Clearly, we are doing something right. The same can’t be said for states like Texas (4,791 new HIV diagnoses in 2008, which is twice as many new diagnoses based on population as Massachusetts) and Florida (7,825 new cases, or 4.5 times as many as Massachusetts).

Those high rates of new diagnoses are what prompted the Centers for Disease Control to recommend that medical providers make HIV testing more routine by eliminating requirements for consent and pre-test counseling. That kind of one-size-fits-all approach to HIV testing might work in Texas and Florida. But it’s a clumsy and wasteful way to diagnose people with HIV in Massachusetts.

Just last week, President Obama released his National HIV/AIDS Strategy which calls for the use of local, evidence-based, cost-effective solutions to fight the epidemic. Examples of local solutions include the Massachusetts Department of Public Health’s six targeted pilot HIV testing programs that have resulted in more high-risk people being tested and connected with care. Everyone who is tested also receives intensive education about HIV and how to keep themselves and their families safer. AIDS Action has long offered similar services at The MALE Center in the South End.

These programs show the need for expanded HIV testing in Massachusetts. That’s why the AIDS Action Committee, Victory Programs, AIDS Project Worcester, Massachusetts Medical Society, JRI Health and the Massachusetts Hospital Association supported a compromise bill passed by the Joint Committee on Public Health to expand HIV testing in the state. This bill was developed with significant input from people across the state and under the leadership of state Rep. Jeffrey Sánchez, co-chair of the Joint Committee on Public Health.

The bill would have modernized our HIV testing law by eliminating the need for written consent for an HIV test and replaced it with verbal consent with a doctor’s note in the patient’s medical records. The proposed law kept all privacy protections intact for people with HIV.

Just weeks ago, without public comment or input, the bill was reported out of another committee, the Joint Committee on Health Care Financing, with significant changes: Patients must elect to opt out of HIV testing, and medical providers would no longer be required to obtain a separate written consent for each disclosure of a patient’s HIV status.

Imagine how much more we could accomplish if lawmakers rejected an expensive one-size-fits-all approach to HIV testing and instead funded a local solution. The compromise bill passed by the Joint Committee on Public Health accomplished something you don’t often see in politics: consensus. Its passage—with real verbal consent and privacy protections intact—might do something else as well: help Massachusetts eliminate new HIV infections.